Individual
SHEILA R. GOFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
215 N KANSAS ST, WEATHERFORD, OK 73096-5443
(580) 772-5551
Mailing address
2411 SW 122ND ST, OKLAHOMA CITY, OK 73170-4844
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
897
OK
363AM0700X
Medical Physician Assistant
Primary
897
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100119390C
—
OK
Enumeration date
05/16/2006
Last updated
05/29/2024
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